New Data-Based TJR Tool for Patients; New OA Patient Guidelines; Using Behavior Science to Improve TJR Outcomes

New Data-Based TJR Tool for Patients

Thanks to work from the University of Massachusetts Medical School (UMMS)-led Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR), patients will someday be able to compare their personal information with nationwide data to help decide if and when to undergo TJR.

The five-year study, which will be using information from dozens of orthopedic sites, is being funded by a $6.4 million grant from the Patient-Centered Outcomes Research Institute. Twenty-five surgeons are participating and the hope is that they will be able to enroll 8,000 patients in the study. Arthritis care through Shared Knowledge (A.S.K.) promises to help clarify guidelines on if and when to have surgery.

Patricia Franklin, M.D., M.B.A., M.P.H., professor of orthopedics and physical rehabilitation and principal investigator in the study, told OTW, “Good data. We want to calculate likely predicted outcomes using high quality, nationally representative data. FORCE-TJR is a wonderful resource as it is a national representative sample from 28 states/>200 surgeons with little data missing. Other data bases are skewed—for example, the EMR [electronic medical record] may have data only from one health system or a convenience sample of users of one commercial EMR or patients who are doing well do not come to the office (so the EMR is missing the outcome data). FORCE routinely collects outcomes on all patients—whether they go to the office or not—using direct-to-patient contact.”

“It was also challenging to integrate the new reports into the office flow for optimal use. To get the best value from the new, shared reports, patients answer the A.S.K surveys before the office visit so the real-time report is available for the patient and clinician to view.”

“The information technology is the easy part—it scores and does the statistical modeling in seconds. However, patients must complete the survey before arriving at the office or on arrival at the office. Our system sends the survey via email to the patient home, and reminds them to complete it in advance of the visit. If not completed at home, many surveys are completed in the office because the EMR did not have an updated email, or the patient does not use in home technology. These challenges will be resolved in the future as adults routinely use phone apps, web, etc.”

As for what about the care decision process patients struggle with, Dr. Franklin told OTW, “Timing. Patients ask, ‘When is optimal? Are my symptoms severe enough to warrant surgery?’ The report places their symptoms in context with others who elected surgery. This helps patients understand ‘when.’ They also ask, ‘What are the benefits and risks of other treatment options?’ We provide evidence-based information on alternatives (physical therapy, medications, injections).”

“They want to know about their personal risk factors that may affect their outcomes. The surgeon is the best person to review the risks with the patient, but the report lists the key factors for each individual.”

“In addition, they want to know, ‘How do patients like me benefit from surgery?’ The report provides individualized likely surgical benefits in lay language.”

“Patients are very willing to complete the symptom and risk assessment (including patient-reported outcome measures) when the data inform their care.”

“Because we can translate the surveys into real-time personalized information, patients are very engaged partners. We interviewed many patients during the report development phase to assure that we present the information as clearly as possible for patients.”

“Collecting key data once can serve both shared individual decisions, and also be aggregated for quality incentives and bundled payment programs. The same data are used in both.”

New OA Patient Guidelines

Upper Nyack, New York-based CreakyJoints has announced the publication of “Raising the Voice of Patients: A Patient’s Guide to Living With Osteoarthritis.”

According to CreakyJoints Co-Founder and Executive Director Louis Tharp: “The OA [osteoarthritis] patient guidelines help the newly diagnosed, as well as experienced patients like me, better understand our management options. We are able to position ourselves as a significant voice in determining our care. They help me communicate treatment preferences and goals that fit my lifestyle.”

The editors of “Raising the Voice of the Patients: A Patient’s Guide to Living with Osteoarthritis,” were David Borenstein, M.D., clinical professor of Medicine, Division of Rheumatology at The George Washington University Medical Center in Washington, DC, Jonathan Krant, M.D., chairman of Medicine & section chief of Rheumatology, Adirondack Health Systems, Saranac Lake, New York, and Tuhina Neogi, M.D., Ph. D., professor of Medicine, Boston University School of Medicine, professor, Epidemiology, Boston University School of Public Health.

Dr. Borenstein told OTW, “What I found most interesting in helping edit the OA guideline was realizing the number of non-pharmacological and pharmacological therapies that are available for the treatment of the most common form of arthritis. From losing weight, to walking, to oral treatment, to injections, a number of interventions can make a difference in the function of people with osteoarthritis.”

“I think the most important recommendation to patients with osteoarthritis is that they should not give up if a therapy does not work. The goal of therapy is function, not total pain relief. Patients respond to different therapies. It is a trial and error method to find the one that works for that individual. Osteoarthritis patients should read through the guideline and choose the therapies that make sense to them and try them. The expectation is that one or another will work and readers of this guideline will be better.”

The Medical Advisor for CreakyJoints, Vinicius Domingues, M.D., told OTW, “I believe the guideline is a powerful tool for patients to inform themselves about OA and review the options available for treatment. It is very important to address, especially with regards to knee OA, that weight loss is pivotal to decrease progression of cartilage loss and to alleviate the pain.”

“Often times, I even suggest, for patients that qualify, to undergo bariatric surgery or gastric sleeve if they had failure aggressive weight loss program. Furthermore, the guidelines outline in detail the options for treatment and potential side effects of all medications. Unfortunately, the landscape for OA has not changed dramatically in the last 20 years but we have some promising agents under investigation and in the next 5-10 years I believe the field will be revolutionized. One other important and necessary message is that opioids are not really the most efficacious treatment option and they carry significant side effects.”

Using Behavior Science to Improve TJR Outcomes

Johnson & Johnson (JNJ) Health and Wellness Solutions, Inc., one of a number of companies selected by the FDA to participate in a pilot program to streamline the digital health regulation process, has introduced a new digital platform.

According to JNJ, the Health Partner platform “is a sophisticated digital platform that combines behavior science with technology to bring new levels of understanding and analysis to providers and health systems. Because its three tools are ‘connected,’ Health Partner learns with the patient and his or her care team, enabling care that adapts over time based on an individual’s changing needs and behaviors.”

“The platform is currently available for patients undergoing knee or hip surgery. Health Partner also connects patients and their providers seamlessly, allowing for two-way communication and providing a supportive, tailored experience that promotes patient education, engagement and adherence.”

“Healthcare is personal, and helping people achieve their best health is deeply rooted in our commitment as a healthcare company,” said Sandra (Sandi) Peterson, Group Worldwide Chair, Johnson & Johnson. “Health Partner has been designed with the ‘whole person’ experience in mind to help ensure better engagement between patients and their healthcare team, and get patients back to living their lives—because we know that will help enhance efficiencies and quality of care.”

Rodrigo Diaz, M.D., franchise medical director at DePuy Synthes, told OTW, “At Johnson & Johnson, helping people achieve their best health is deeply rooted in our commitment as a healthcare company. Transforming the way healthcare is designed and delivered is mission critical and technology is powering that work. We interconnect expertise across our businesses to reshape the way healthcare is delivered, managed and experienced.”

“Health Partner was designed to help patients prepare physically, mentally and emotionally for surgery by connecting them with their healthcare team to ensure customized, real-time care. It learns with the user over time and provides personalized patient care that adapts based on each patient’s changing needs and behaviors.”

“Health Partner puts patients at the center and includes three connected digital tools: the HealthPartner.com website provides education and resources before treatment even begins; the Health Partner mobile app helps guide a patient through surgical preparation and recovery; and the Health Partner care portal, designed for providers and health systems, enables real-time interaction throughout a patient’s treatment journey.”

According to Dr. Diaz, “Health Partner focuses on improving a patient’s ability to stick with their care plan by addressing the underlying behaviors that might hinder success, while also providing tools and support to keep patients motivated and engaged throughout their surgical journey.”

“Health Partner does this by engaging patients early in their journey, from initial education about treatment options through to encouraging health behaviors to help enable long-term success; addressing many of the emotional challenges patients could face—fear, uncertainty and confusion—building confidence in treatment decisions; and focusing on patient preparedness and fostering greater confidence in their ability to return to better health.”

“We understand the patient journey doesn’t begin and end in the operating room—and many people with chronic hip and knee pain wait an average of 7-11 years before having total joint replacement surgery. It’s a personal, physical and emotional road that starts well before getting to the surgeon’s office and lasts far beyond the final post-op check-up. Health Partner brings new levels of understanding and analysis to surgeons and their teams through its care portal, enabling them to personalize care and improve the patient experience like never before. These benefits can translate into more educated, engaged, satisfied and compliant patients with improved outcomes and greater cost savings for the healthcare system.”